By Lynn Durmala, APN-C, ACHPN, Advanced Certified Hospice and Palliative Nurse, Virtua Palliative Care

A sudden illness or unexpected injury can leave you unable to make your own medical decisions. If a crisis hits, would your family know what kind of medical treatment you want—or don't want?

Taking the time for advance care planning ensures that your voice is heard, even if you can't speak for yourself. It's an essential step for every adult, regardless of age or current health status.

What is advance care planning?

Advance care planning is a way to discuss and document your preferences for the kind of care and treatment you would want, ensuring those involved in your care understand your wishes.

This process often results in legal documents known as advance directives. These documents only go into effect if you become unable to communicate your own choices due to illness or injury.

The two core components of an advance directive:

• Health care proxy (surrogate decision maker): Naming a person you trust to make medical decisions on your behalf if you cannot. This role is also known as a healthcare power of attorney or durable power of attorney for health care.
• Living will: A written document that outlines your specific preferences for medical interventions, such as life support, ventilators, or feeding tubes.

How to discuss and document your health care wishes

The hardest part of advance care planning is often starting the dialogue. The goal is to choose a health care proxy who will listen, talk openly with you, and commit to honoring your choices when they're under pressure.

It’s important to have conversations about your values and how you would feel about your quality of life in specific medical scenarios, including:

• Being unable to ever leave home or bed
• Living with severe, chronic pain most of the time
• Requiring 24-hour assistance for personal needs (feeding, bathing, dressing)
• Living permanently in a long-term care or nursing facility
• Being unable to recognize family or friends

It’s also important to document your preferences. Putting your plan in writing helps those who care for you know your wishes, so you get the care that you want.

Recommended advance care planning resources

The good thing is that you don't have to figure this out on your own. Several trusted public health initiatives offer frameworks to guide your conversations and document your wishes.

• The Conversation Project: This dedicated public service initiative is aimed at helping people talk about their wishes for care through the end of life. The website offers free, downloadable "starter kits" in several languages to help you choose a health care proxy and open the dialogue with your family.
• Five Wishes: This online resource can help reframe your conversations from a cold legal process to a personal, value-driven discussion. It addresses your medical, personal, emotional, cultural, and spiritual wishes. For a small fee ($5), you can complete a legally valid digital or paper document to share with your loved ones and/or you can upload and share it from this national repository.
• Conversation of Your Life (COYL): This COYL handout is part of the New Jersey Health Care Quality Institute’s Mayors Wellness Campaign initiative. It's a statewide program that provides education and resources on how to share your wishes for care and what you need to know about picking a health care proxy.

Medical orders vs. advance directives: understanding the POLST form

As you document your wishes, it's important to understand the difference between a standard advance directive and a medical order, such as the Practitioner Orders for Life-Sustaining Treatment (POLST) form.

While an advance directive is a statement of your personal wishes, a POLST is an actionable medical order signed by a doctor, advanced practice nurse (APN-C), or physician assistant (PA).

After discussing your preferences and goals, your provider can complete and keep the POLST form in your medical record and use it to guide your future care.

NOTE: If you're outside of New Jersey, CaringInfo provides downloadable advance directive forms by state.

Why advance care planning matters

Talking about serious illness or end-of-life care with your family and friends is undeniably difficult. However, advance care planning helps you maintain control should you ever face a medical crisis that leaves you unable to speak for yourself.

It’s also one of the kindest things you can do for your family and friends. It relieves them of the stress of making difficult decisions and gives them peace of mind knowing that they’re honoring your wishes.

For more guidance, talk to your Virtua Primary Care practitioner.